Assessing patient adherence to anti‐hypertensive drug therapy: can a structured pharmacist‐conducted interview separate the wheat from the chaff?

Objective To identify determinants of adherence and assess the impact of structured pharmacist‐conducted interviews in determining patients' adherence to prescribed anti‐hypertensive medications in a secondary care setting in Nigeria. Method The study was conducted in a secondary care facility located in Ibadan, Southwestern Nigeria. Two methodological approaches were employed. The first phase was pharmacist‐conducted, pre‐physician consultation, cross‐sectional interviews of 400 hypertensive patients who presented at the study site within the 2‐month study period. The second phase was a follow‐up review of case notes of these patients after they had left the physician's office. Key findings The outcome of the pharmacist‐conducted pre‐physician consultation interview shows that financial difficulty was the most frequently identified factor responsible for patients' non‐adherence to anti‐hypertensive drug therapy (64%). A drug holiday, varying from 5–14 days per month, was the coping strategy adopted by patients to circumvent this difficulty. Only 48% (192) of patients were aware of the negative consequences of non‐adherence with anti‐hypertensive drug therapy, and of these, 75% were adherent. The level of awareness was significantly higher in adherent patients (P < 0.001). Sixty‐seven per cent (268) of patients use a daily medication reminder (DMR) to assist them in taking their anti‐hypertensive drugs, and of these 65.7% were adherent. The use of DMRs was significantly higher among adherent patients (P < 0.01). A meal time was the most frequently used DMR (88%). Forty‐one per cent (164) of patients had additional measurement of their blood pressure at pharmacies (65.9%) and neighbourhood private hospital (34.1%), and of these 75.6% were judged to be adherent with their prescribed drug therapy. Additional measurement of blood pressure was significantly higher in adherent patients (P < 0.001). Fifty‐one per cent of the cohort were judged by pharmacists as non‐adherent during pre‐consultation interviews (phase 1), while physicians judged 25% of the same cohort as non‐adherent during consultation (phase 2). The structured pharmacist‐conducted pre‐physician consultation interviews were significantly better at identifying patients who were non‐adherent with prescribed anti‐hypertensive drugs (P < 0.01). Conclusion A brief structured pharmacist‐conducted interview can be a valuable tool in assessing and/or identifying determinants of adherence with anti‐hypertensive drug therapy.     

Evaluation of anti‐angiogenic,anti‐inflammatory and antinociceptive activity of coenzyme Q10 in experimental animals

Objectives This work aimed to assess some pharmacological activities of coenzyme Q₁₀ (CoQ₁₀) in animal experimental models. Methods The chick chorioallantoic membrane assay was used to evaluate anti‐angiogenic activity of CoQ₁₀. Anti‐inflammatory activity of CoQ₁₀ was confirmed using two animal models of inflammation. These were the vascular permeability and air pouch models, models of acute and sub‐acute inflammation, respectively. Antinociceptive activity was assessed by the acetic acid‐induced abdominal constriction response. Key findings CoQ₁₀ dose‐dependently displayed inhibition of chick chorioallantoic membrane angiogenesis. In the acetic acid‐induced vascular permeability model in mice, CoQ₁₀ at 50, 100 and 200 mg/kg reduced vascular permeability from 0.74 ± 0.01 (A₅₉₀) to 0.67 ± 0.01 (P < 0.01), 0.46 ± 0.02 (P < 0.01) and 0.30 ± 0.01 (P < 0.01), respectively. In the carrageenan‐induced inflammation in the air pouch, CoQ₁₀ was able to diminish exudate volume, the number of polymorphonulcear leucocytes and nitrite content in the air pouches. CoQ₁₀ at 25, 50 and 100 mg/kg significantly reduced acetic acid‐induced abdominal constriction in mice from 27.0 ± 2.00 (number of abdominal constrictions) to 17.7 ± 0.33 (P < 0.01), 9.3 ± 0.67 (P < 0.01) and 1.3 ± 0.33 (P < 0.01), respectively, suggesting a strong antinociceptive activity. Conclusions CoQ₁₀ possessed considerable anti‐angiogenic, anti‐inflammatory and antinociceptive activity, possibly via down‐regulating the level of nitric oxide, which partly supported its use as a dietary supplement and in combination therapy.     

A nationwide prospective study on prescribing pattern of antidepressant drugs in Italian primary care

Purpose

Our purpose was to explore antidepressant drug (AD) prescribing patterns in Italian primary care.

Methods

Overall, 276 Italian general practitioners (GPs) participated in this prospective study, recruiting patients >18 years who started AD therapy during the enrolment period (January 2007 to June 2008). During visits at baseline and 3, 6, and 12 months, data about patients’ characteristics and AD treatments were collected by the GPs. Discontinuation rate among new users of AD classes [i.e., selective serotonin reuptake inhibitors (SSRI); tricyclics (TCAs); other ADs) were compared. Logistic regression analyses were performed to identify predictors of AD discontinuation.

Results

SSRIs were the most frequently prescribed ADs (N?=?1,037; 75.3 %), especially paroxetine and escitalopram. SSRIs were more likely to be prescribed because of depressive disorders (80 %), and by GPs (51.1 %) rather than psychiatrists (31.8 %). Overall, 27.5 % (N?=?378) of AD users discontinued therapy during the first year, mostly in the first 3 months (N?=?242; 17.6 %), whereas 185 (13.4 %) were lost to follow-up. SSRI users showed the highest discontinuation rate (29 %). In patients with depressive disorders, younger age, psychiatrist-based diagnosis, and treatment started by GPs were independent predictors of SSRI discontinuation.

Conclusions

In Italy, ADs—especially SSRIs—are widely prescribed by GPs because of depressive/anxiety disorders. Active monitoring of AD users in general practice might reduce the AD discontinuation rate.